Mental illness through the perspective of undergraduate medical students in Greece: a cross-sectional study at Aristotle University of Thessaloniki.

Introduction: Numerous studies reveal that mental health-related stigma, stereotypes, and prejudices negatively affect the patients, jeopardizing their health, prognosis, and social opportunities. Healthcare professionals, who are in the first line of combating mental disease, are expected to play a significant role in drastically changing discriminatory and stigmatizing attitudes toward psychiatric patients and in diminishing the existing healthcare and social disparities. In this study, we aimed to explore and highlight the views of Greek medical students-that is of the future physicians-toward mental illness and people suffering from it. Materials and methods: It is a cross-sectional, observational study, in which 324 undergraduate students from the most populous Greek medical school of the Aristotle University of Thessaloniki, participated online, during the spring semester of 2022. The tools used were the Opinions about Mental Illness Scale (OMI) that assesses one's viewpoints about mental illness, the Social Distance Scale (SDS) that captures the desired degree of social distancing from patients with mental disorders, and the Level of Contact Report (LCR-12) that estimates the level of familiarity with them. Results: Participants displayed rather positive attitudes regarding the etiology of mental illness, social integration, and discrimination toward psychiatric patients [as evaluated with the respective OMI subscales; Etiology mean score (µ):8.87 ± 4.68, Social Integration (µ):17.79 ± 5.42, Social Discrimination (µ):13.54 ± 11.17], and more clearly favorable opinions concerning the need for social provision or the enactment of restrictive measures [as expressed with the relative OMI subscales; Social Care (µ):22.74 ± 4.56, Social Restriction (µ):13.27 ± 8.98], while claiming to be quite familiar with mental disorders and individuals experiencing them (as assessed with LCR; µ: 8.71 ± 2.16), and relatively willing to interact with them (as measured with SDS; µ:8.95 ± 4.23). Degree of familiarity with mental illness was directly proportional to the desire for contact with patients living with it, while the higher both were, the more improved most of the aforementioned OMI sectors were found to be. Female sex, clinical medical education, previous clinical psychiatric training, and living with or being a person with a mental disorder were the factors that defined a statistically refined profile in many of the aspects above. Conclusion: Our findings are in accordance with many prior and recent studies, while showing improved opinions compared to those of previous research in Greek student and healthcare population. They are calling for vigilance, rather than complacency, as well as educational and social interventions, in order to enable current and future healthcare professionals to perform their function to its fullest extent. Implications of our results and further research suggestions are included.

Mental health-related stigma discrimination and prejudices among Greek healthcare professionals.

Introduction: Research shows that mental health-related stigma, stereotypes, and prejudices have a negative impact on the patients themselves as well as on their families and social entourage. Healthcare professionals, whose expertise and professional ethos are historically acknowledged by public opinion, are expected to play a major role in combating discrimination against psychiatric patients. In this study, we aimed to assess the attitudes of Greek healthcare professionals toward mental illness and people suffering from it. Materials and methods: It is a non-interventional, analytic study, in which 479 health workers from a tertiary hospital in Thessaloniki, Greece, participated. Every single hospital service -except the personnel of the Psychiatric Clinic- was included in our study: from the cleaning service to the administrative staff and the auxiliary staff such as stretcher carriers, food and nutrition services' staff, and social workers, the nursing staff, and finally the attending physicians, taking into consideration that the psychiatric patient, from the moment he/she enters the hospital, consecutively gets in contact with every work grade of the healthcare establishment. Participants' attitudes concerning mental illness have been evaluated using the Opinions about Mental Illness Scale (OMI), the Social Distance Scale (SDS), and the Level of Contact Report (LCR-12). Results: Despite the high level of familiarity [as evaluated with LCR-12; mean score (µ): 8.82 ± 1.73], the employees displayed a rather poor willingness to interact with psychiatric patients (as measured with SDS; µ:11.68 ± 4.28), and endorsed significant prejudice toward individuals with mental disorders (assessed using OMI subscales; Social Discrimination µ: 22.99 ± 12.08, Social Restriction µ: 17.45 ± 9.07, Social Care µ: 21.04 ± 4.12, Social Integration µ: 16.38 ± 4.68, Etiology µ: 9.80 ± 4.95). Age and education stood out as the main determinants of participants' attitudes, with younger and highly educated participants to have shown a relatively refined profile. Conclusion: These results are not significantly improved compared to those of previous decades in Greek healthcare professionals and call for critical reflection and targeted stigma-reduction efforts.

Assess of Combinations of Non-Pharmacological Interventions for the Reduction of Irritability in Patients with Dementia and their Caregivers: A Cross-Over RCT.

INTRODUCTION: Dementia is a very common disorder that affects people over 65 years old all over the world. Apart from the cognitive decline, Behavioral and Psychological Symptoms of Dementia (BPSD) are a crucial matter in dementia, because they affect up to 90% of the patients during the course of their illness. Irritability has been found to be a common BPSD and one of the most distressing behaviors for the caregivers. The aim of the current study was to explore the efficacy of a combination of non-pharmacological interventions to treat irritability. METHODS: Sixty patients with different types and stages of dementia with irritability were participated in a cross-over RCT. Three non-pharmacological interventions were used; (a) Validation Therapy (VT)/Psycho-educational program, (b) Aromatherapy/massage and (c) Music Therapy (MT). The study assessed the three non-pharmacological interventions in order to find the most effective combination of the interventions. This study did not compare pharmacological and non-pharmacological treatments. The interventions lasted for five days. There was no drop-out rate. All patients were assessed at baseline using Mini Mental State of Examination (MMSE), Addenbrooke's Cognitive Examination Revised (ACE-R), Geriatric Depression Scale (GDS), Functional Rating Scale for symptoms in dementia (FRSSD), and Neuropsychiatric Inventory (NPI) (sub questions for irritability). Only NPI used for the assessment after each intervention. The analyses used categorical variables, Wilcoxon signed-rank test, Chi-square test and z value score. RESULTS: The most effective combination of non-pharmacological interventions was Aromatherapy/massage (p = 0.003)-VT plus Psycho-educational program (p = 0.014) plus MT (p = 0.018). The same combination was the most effective for the caregivers' burden, too (p = 0.026). CONCLUSIONS: The above combination of non-pharmacological interventions can reduce irritability in patients with dementia and caregivers' burden.

Adherence to facemask use in public places during the autumn-winter 2020 COVID-19 lockdown in Greece: observational data.

BACKGROUND: Wearing facemasks is of proven efficacy as a public health protective measure against COVID-19. Currently there are no observational data concerning the wearing of facemasks and the adherence to guidelines concerning their handling. METHODS: Registration of the way passers-by were wearing facemasks at 26 different locations of five major cities in Greece. The results were correlated with the rate of COVID-19 deaths in the region. RESULTS: In total, 119,433 passers-by were registered, 57,043 females (47.8%) and 62,390 males (52.2%). From the total sample, 81.1% were wearing the mask properly, 10.8% had their nose out, 6.2% were wearing it under the jaw, and 1.9% had no mask at all . There was a significant difference between males and females concerning any use of mask. Inappropriate use of was correlated with COVID-19 death rate in the studied region. CONCLUSION: Our findings suggest that under conditions of mandatory wearing and in central locations of major cities, during walking, proper use of masks is suboptimal, but still contributes with some protection. Fear and risk perception seem to be strong factors contributing to adherence to proper mask wearing.

Non-Pharmacological Interventions for Wandering/Aberrant Motor Behaviour in Patients with Dementia.

BACKGROUND: Aberrant motor behaviour or wandering refers to aimless movement without a specific purpose. Wandering is common in patients with dementia and leads to early institutionalization and caregivers' burden. Non-pharmacological interventions should be also considered as a first-line solution for the wandering because current pharmacological treatment has serious side-effects. METHODS: A cross-over randomised controlled trial (RCT) with 60 participants of all stages and different types of dementia was conducted in Greece. The sample was randomly assigned in 6 different groups of 10 participants each. Every intervention lasted for 5 days, and there were 2 days as a wash-out period. There was no drop-out rate. The measurements used were the Mini Mental State Examination (MMSE), Addenbrooke's Cognitive Examination Revised (ACE-R), Geriatric Depression Scale (GDS), Functional Rating Scale for Symptoms in Dementia (FRSSD), and Neuropsychiatric Inventory (NPI). The interventions that were evaluated were reminiscence therapy (RT), music therapy (MT), and physical exercise (PE). RESULTS: NPI scores were reduced in the group receiving PE (p = 0.006). When MT (p = 0.018) follows PE, wandering symptoms are reduced further. RT should follow MT in order to reduce wandering more (p = 0.034). The same combination was effective for the caregivers' burden as well; PE (p = 0.004), MT (p = 0.036), RT (p = 0.039). CONCLUSIONS: An effective combination that can reduce wandering symptoms in all stages and types of dementia was found: The best order was PH-MT-RT. The same combination in the same order reduced caregivers' burden.

Mental health and conspirasism in health care professionals during the spring 2020 COVID-19 lockdown in Greece.

INTRODUCTION: The aim of the study was to investigate mental health and conspiracy theory beliefs concerning COVID-19 among health care professionals (HCPs). MATERIAL AND METHODS: During lockdown, an online questionnaire gathered data from 507 HCPs (432 females aged 33.86 ± 8.63 and 75 males aged 39.09 ± 9.54). STATISTICAL ANALYSIS: A post-stratification method to transform the study sample was used; descriptive statistics were calculated. RESULTS: Anxiety and probable depression were increased 1.5-2-fold and were higher in females and nurses. Previous history of depression was the main risk factor. The rates of believing in conspiracy theories concerning the COVID-19 were alarming with the majority of individuals (especially females) following some theory to at least some extend. CONCLUSIONS: The current paper reports high rates of depression, distress and suicidal thoughts in the HCPs during the lockdown, with a high prevalence of beliefs in conspiracy theories. Female gender and previous history of depression acted as risk factors, while the belief in conspiracy theories might act as a protective factor. The results should be considered with caution due to the nature of the data (online survey on a self-selected but stratified sample).

Clinical Profiles and Socio-Demographic Characteristics of Adults with Specific Learning Disorder in Northern Greece.

The manifestation of Specific Learning Disorder (SLD) during adulthood is one of the least examined research areas among the relevant literature. Therefore, the adult population with SLD is considered a "rare" and "unique" population of major scientific interest. The aim of the current study was to investigate, describe, and analyze the clinical, academic, and socio-demographic characteristics, and other everyday functioning life-skills of adults with SLD, in an attempt to shed more light on this limited field of research. The overall sample consisted of 318 adults, who were assessed for possible SLD. The diagnostic procedure included self-report records (clinical interview), psychometric/cognitive, and learning assessments. The main finding of the study was that SLD, even during adulthood, continues to affect the individuals' well-being and functionality in all of their life domains. There is an ongoing struggle of this population to obtain academic qualifications in order to gain vocational rehabilitation, as well as a difficulty to create a family, possibly resulting from their unstable occupational status, their financial insecurity, and the emotional/self-esteem issues they usually encounter, due to their ongoing learning problems. Moreover, the various interpersonal characteristics, the comorbidity issues, and the different developmental backgrounds observed in the clinical, academic, personal, social, and occupational profiles of the participants, highlight the enormous heterogeneity and the continuum that characterizes SLD during adulthood. We conclude that there is an imperative need for further research and the construction of more sufficient tools for the assessment and diagnosis of SLD during adulthood, which will take into account the developmental challenges and milestones in a series of domains, in order to assist this "vulnerable" population with their life struggles.

Improvement of Medical Students' Empathy Levels After an Intensive Experiential Training on Empathy Skills.

Background: EMPATHY IN HEALTHCARE is an intensive 20-hour experiential training program based on mediation techniques and specialized healthcare role-play for clinicians and medical students. It is hypothesized that the training will improve empathy via the intensive experiential techniques implemented. Methods: A total of 50 medical students (25 males/25 females) took the course voluntarily. Empathy was measured using the Jefferson Scale of Empathy-Medical Students Version (JSE-S) (Greek version), before and after the 20-hour training, along with a 6-month follow-up. Gender, age, preferred medical specialty and baseline empathy score were explored as possible moderator variables of the training effect. Results: Empathy increased after training, with a mean JSE-S score improvement of 11.25 points (±8.848) (P < .001). After 6 months, the mean JSE-S score maintained a difference of 6.514 points (±12.912) (P < .005). No differences were recorded with regard to gender, age group or medical specialty for the pooled data. Women in the 22-24 year-old age group had a 5-point mean difference (P = .05), and higher post-training scores than men. Lower initial scorers were the ones that mostly improved, with a 3-fold mean score difference from the higher scorers regardless of gender (P < .001), while also showing a smaller drop in empathy levels 6 months after the training compared to the higher scorers. Conclusion: Intensive experiential training can improve empathy in a clinical setting. EMPATHY IN HEALTHCARE is a successful training program in improving empathy in medical students, as measured by the JSE-S. A score of 110 and below could be used for selecting medical student candidates who will benefit most from empathy training.

Psychopathology, psychosocial factors and sexuality of incarcerated sexual offenders in Greek prison.

There are few studies in Greece on sexual offenders. The research aims to contribute knowledge and information related to psychopathology, psychosocial factors and the sexuality of this particular category of convicts for sexual offenses. The search took place in the Greek prison in Grevena, where the largest number of sexual offenders are being held. This is a quantitative study and descriptive and inferential statistical methods were used. The study involved 127 sexual detainees and used the STAI, BDI, EPQ, SCL-90 questionnaires and a special sexual behavior questionnaire. The reliability of the tools was high as the lowest price of Cronbach alpha was equal to 0.733 (STAI) and the highest was 0.975 (SCL-90). The Special Sexual Behavior Questionnaire was 0.877 reliable. RESULTS: The results of the research confirmed the heterogeneity of the population of sexual perpetrators in many categories of data. The importance of some factors such as abuse in childhood, substance use, difficulty in having close relationships, and young delinquent behaviour in the subsequent delinquent evolution of the individual also emerged. Our study did not show particularly high levels of psychopathology except for some elements of anxiety and depression. The results also showed the existence of high transient anxiety, while in the subscales Paranoid Idea and Compulsiveness we had the highest average scores and lower in the subscales Phobic Stress, Aggression and Psychoticism. We had high scores on the scale Neuroticism-Stability and the lowest on the scale Psychoticism-Superego. There were no significant differences between adult and pediatric rapists in terms of differences in stress levels and depression. Sexual perpetrators against minors had higher scores than the dimensions Psychoticism-Superego and Neuroticism-Stability. Minor statistically significant differences in the dimensions Aggression, Anxiety, Paranoid Idea and Neuroticism-Stability were also found. The results show that juvenile delinquency is becoming more serious and violent. Substance users are less likely to sexually abuse a minor. As for the early onset of sexual activity, it appears to be associated with an increased risk of adult rape as well as the fact that the perpetrator's sexual abuse during childhood increases the likelihood that as an adult he or she will harm his or her relatives. In terms of sexual behaviour, incarceration in prison burdened almost all sexual problems of detainees with statistically significant differences in sexual desire and erection problems. There was a universal reduction in the sexual behavior of sexual offenders in prison and a universal reduction in all sexual practices used before imprisonment. Masturbation is the main sexual practice in prison. The main gender of sexual attraction is women despite its significant statistical decline. Statistically, attraction to underage girls has also declined, while homosexual and bisexual tendencies have increased, but there are no statistically significant differences. There was also a significant decrease in the use of pornographic material with adult women and minors, while the use of pornographic material with homosexual content increased. CONCLUSIONS: The investigation of psychopathology, sexual behaviour and those psychosocial factors that characterize and determine the lives of sexual offenders, offers important data and knowledge on which we will rely for the development of therapeutic and preventive programs. Future research on sex offenders should focus on further research on psychopathology and how to think about it, as well as the possibility of using reliable relapse prevention tools to protect society as a whole.

Non-Pharmacological interventions for the anxiety in patients with dementia. A cross-over randomised controlled trial.

BACKGROUND: Behavioural and Psychiatric Symptoms in dementia (BPSD) tend to be a crucial and big problem in dementia. Anxiety several times remains under-diagnosed because it is often considered to be a psychological response to cognitive decline. As only the 10 % of patients were correctly treated, the pharmacological treatment should be well- considered. The aim of this study was to evaluate three non-pharmacological interventions for the treatment of anxiety in dementia. METHODS: A cross-over randomised controlled trial with 60 participants (different types and stages of dementia) conducted in Greece. The sample was randomly assigned to 6 different groups of 10 participants each. The non-pharmacological interventions that have been evaluated are: a) Music Therapy b) Exercise and c) Aromatherapy & Massage. The measurements that were used are: MMSE, ACE-R, GDS, FRSSD and NPI questionnaire. The interventions lasted 5 days and there was two days off as a wash-out period. There was no drop-out rate. RESULTS: The study showed that the most effective intervention is Music therapy. The second most effective intervention is Exercise and the third one is Aromatherapy and Massage. In the parenthesis p results indicate that Music Therapy's p is less than 0.05 in comparison with Exercise and Aromatherapy and Massage and therefore the sequence of the interventions does not interfere with the results. (p = <0.05, p = 0.55, accordingly). Caregivers' burden also reduced with MT. In the parenthesis p results indicate Music Therapy's p is less than 0.05 in comparison with the two other interventions and therefore the sequence of the interventions does not interfere with the results, as well (p = <0.05, p = 0.19). CONCLUSIONS: Our results are in accordance with the current literature. Music Therapy is a promising alternative intervention for the treatment of anxiety in PwD. Music Therapy is an effective non-pharmacological treatment for the reduction of the caregivers' burden, because of the anxiety symptoms in PwD, such as lack of sleep, lack of personal time, unhealthy lifestyle, lack of solutions on what to do with their patients etc. The type of music, the duration of the intervention and the long-term benefits remain unclear. There is a big need of further research with stronger possible evaluation methods.

Nilvadipine in mild to moderate Alzheimer disease: A randomised controlled trial.

BACKGROUND: This study reports the findings of the first large-scale Phase III investigator-driven clinical trial to slow the rate of cognitive decline in Alzheimer disease with a dihydropyridine (DHP) calcium channel blocker, nilvadipine. Nilvadipine, licensed to treat hypertension, reduces amyloid production, increases regional cerebral blood flow, and has demonstrated anti-inflammatory and anti-tau activity in preclinical studies, properties that could have disease-modifying effects for Alzheimer disease. We aimed to determine if nilvadipine was effective in slowing cognitive decline in subjects with mild to moderate Alzheimer disease. METHODS AND FINDINGS: NILVAD was an 18-month, randomised, placebo-controlled, double-blind trial that randomised participants between 15 May 2013 and 13 April 2015. The study was conducted at 23 academic centres in nine European countries. Of 577 participants screened, 511 were eligible and were randomised (258 to placebo, 253 to nilvadipine). Participants took a trial treatment capsule once a day after breakfast for 78 weeks. Participants were aged >50 years, meeting National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's disease Criteria (NINCDS-ADRDA) for diagnosis of probable Alzheimer disease, with a Standardised Mini-Mental State Examination (SMMSE) score of ≥12 and <27. Participants were randomly assigned to 8 mg sustained-release nilvadipine or matched placebo. The a priori defined primary outcome was progression on the Alzheimer's Disease Assessment Scale Cognitive Subscale-12 (ADAS-Cog 12) in the modified intention-to-treat (mITT) population (n = 498), with the Clinical Dementia Rating Scale sum of boxes (CDR-sb) as a gated co-primary outcome, eligible to be promoted to primary end point conditional on a significant effect on the ADAS-Cog 12. The analysis set had a mean age of 73 years and was 62% female. Baseline demographic and Alzheimer disease-specific characteristics were similar between treatment groups, with reported mean of 1.7 years since diagnosis and mean SMMSE of 20.4. The prespecified primary analyses failed to show any treatment benefit for nilvadipine on the co-primary outcome (p = 0.465). Decline from baseline in ADAS-Cog 12 on placebo was 0.79 (95% CI, -0.07-1.64) at 13 weeks, 6.41 (5.33-7.49) at 52 weeks, and 9.63 (8.33-10.93) at 78 weeks and on nilvadipine was 0.88 (0.02-1.74) at 13 weeks, 5.75 (4.66-6.85) at 52 weeks, and 9.41 (8.09-10.73) at 78 weeks. Exploratory analyses of the planned secondary outcomes showed no substantial effects, including on the CDR-sb or the Disability Assessment for Dementia. Nilvadipine appeared to be safe and well tolerated. Mortality was similar between groups (3 on nilvadipine, 4 on placebo); higher counts of adverse events (AEs) on nilvadipine (1,129 versus 1,030), and serious adverse events (SAEs; 146 versus 101), were observed. There were 14 withdrawals because of AEs. Major limitations of this study were that subjects had established dementia and the likelihood that non-Alzheimer subjects were included because of the lack of biomarker confirmation of the presence of brain amyloid. CONCLUSIONS: The results do not suggest benefit of nilvadipine as a treatment in a population spanning mild to moderate Alzheimer disease. TRIAL REGISTRATION: Clinicaltrials.gov NCT02017340, EudraCT number 2012-002764-27.

Development and validation of the Greek severe impairment battery (SIB).

BACKGROUND: Most neuropsychological batteries, especially those most often used, are unsuitable for the assessment of patients with severe dementia. The Severe Impairment Battery (SIB) was developed for the evaluation of preserved cognitive functions in these patients. The aim of this study was to formulate a Greek version of the SIB and to conduct a first assessment of its use of patients with mild, moderate, or severe Alzheimer's disease (AD), compared to the Mini-Mental State Examination (MMSE). METHODS: A convenience sample of 42 dementia patients according to DSM-IV-TR criteria and 23 healthy participants was selected. Patients were assessed twice using a Greek translation of the SIB and the Greek version of MMSE. Patients were divided into three severity groups based on grouped by Clinical Dementia Rating (CDR) score and the SIB and MMSE scores were compared. RESULTS: The validity of the SIB was confirmed by evaluating the correlation coefficients between the SIB and Greek-MMSE, grouped by CDR, which were found to be significant. Cronbach's α for the total SIB score and each subscale score showed high significance, and the item-total correlation for each subscale was also acceptable. The test-retest correlation for the total SIB score and subscale scores were significant. The total SIB score and subscale scores were examined according to CDR. CONCLUSION: The Greek SIB is reliable and valid in differentiating patients with moderate or severe dementia, whereas MMSE loses sensitivity due to a floor and ceiling effect.

The impact of weight loss on depression status in obese individuals subjected to intragastric balloon treatment.

BACKGROUND: Although depression is considered to be significantly related to morbid obesity disorder, no information exists on the evolution of depression status after weight loss, in particular when an intragastric balloon is used. This prospective 6-month study examines both the effect on depression status and the relation of weight loss to depression in morbidly obese patients treated by intragastric balloon. METHODS: One hundred consecutive females fulfilling criteria for balloon treatment were assessed for depression and divided into two groups (65 depressed, 35 non-depressed). Obesity-related parameters were comparable. RESULTS: During the treatment period, the depression status of the mildly, moderately, and severely depressed patients improved from 40, 32.3, and 27.7 % to 20, 7.7, and 1.5 %, respectively, with 70.8 % finally exhibiting no depression at all. During the same period, body weight, BMI, body fat, and excess weight loss (EWL) were comparable between all groups, the range of BMI affecting neither the depression score nor the reduction of obesity parameters. However, there was a significant [percentage of EWL >30] weight loss difference in favor of those who were less severely depressed initially. CONCLUSION: The degree of weight loss observed in obese depressed females-being comparable to that achieved by non-depressed females-after intragastric balloon insertion was found to positively affect their depression status.